Sustained chest pain occurred 3 h after the procedure. Emergent angiography revealed flow-limiting obstruction at the distal stent edge (Fig. 2). Optical coherence tomography showed a hematoma (hypo-backscattering with attenuation) that was clearly located outside of the media, but inside of the adventitia (Fig. 3). Intravascular ultrasound also demonstrated the development of an extramedial hematoma. The mechanism is shown in Figure 4.

We report a progression from dissection to extramedial hematoma. Optical coherence tomography can localize a post-stent hematoma as intramedial or extramedial.

Footnotes

Dr. Mintz has received grant support and consulting fees from Boston Scientific Corporation, InfraRedX, St. Jude Medical, and Volcano Corporation. Dr. Moses has received consulting fees from Boston Scientific Corporation. Dr. Maehara has received grant support and consulting fees from Boston Scientific Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.